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International Trends in Concurrent Hysterectomy at Risk-Reducing Surgery in BRCA1/2 pathogenic variant carriers: A
Tamar A Gootzen1, Barbara M Norquist2, Roni Nitecki Wilke3
1Department of Gynecology and Obstetrics, Radboud University Medical Center, Nijmegen, The Netherlands,.
American Journal of Obstetrics and Gynecology
|June 20, 2026
Summary
Hysterectomy during risk-reducing salpingo-oophorectomy (RRSO) varies significantly worldwide, being more common in the Americas than in Europe. This variation is linked to differing provider interpretations of indications, cultural factors, and a lack of clear guidelines.
Area of Science:
- Gynecologic Oncology
- Cancer Prevention
- Surgical Outcomes
Background:
- BRCA1/2 pathogenic variant (PV) carriers face elevated tubo-ovarian cancer risks, necessitating risk-reducing salpingo-oophorectomy (RRSO) between ages 35-45.
- Concurrent hysterectomy during RRSO is an option, but international practices and decision-making factors remain unclear.
Purpose of the Study:
- To investigate the global variation in concurrent hysterectomy rates during RRSO.
- To identify factors influencing the decision-making process for hysterectomy during RRSO among healthcare providers.
Main Methods:
- A mixed-methods approach combining quantitative analysis of prospective trial data (WISP, TUBA-WISP II) with qualitative focus group interviews of gynecologic providers.
- Quantitative analysis compared hysterectomy rates across continents and analyzed associations with patient characteristics.
- Qualitative analysis explored indications, barriers, and facilitators for hysterectomy during RRSO.
Main Results:
- Hysterectomy rates at RRSO varied significantly: 48.8% in North/South America, 14.2% in Australia, and 2.8% in Europe (p<0.001).
- In the Americas, hysterectomy was more frequent with BRCA1 PVs than BRCA2 PVs (aOR 0.4).
- Qualitative data revealed diverse indications, with significant barriers including lack of guidelines, cultural differences, and varying interpretations of endometrial cancer risk.
Conclusions:
- Significant international disparities exist in performing hysterectomy during RRSO, with higher rates in the Americas.
- Provider interpretation of indications, influenced by cultural variations, lack of guidelines, and limited evidence, likely drives these global differences.
